5 Historical Epidemics that Changed the World

Disease outbreaks are inherent to a populous, globalized world.

Doctors and nurses in biohazard suits during the 1918 Spanish Flu epidemic. National Museum of Health and Medicine. CC0.

Pandemics have been a part of the human story since the agricultural revolution in 10,000 BC. Agriculture gave people the ability to create more food than they ever had before, which meant that the human population soared. People began packing together and settling down in large communities without modern sanitation, creating the ideal conditions for the spread of disease. As time went on, larger and larger communities established extensive trading networks with the ability to spread disease across continents. 

With each disease outbreak, humanity has developed better defenses and practices to help prevent catastrophic losses. However, as long as population sizes continue to rise and the global community becomes ever more interconnected, worldwide pandemics will always be something that humanity must contend with. 

This trend towards an increasingly populous and interconnected world is what fueled the global sweep of the COVID-19 pandemic. As Amesh Adalja, MD, a senior scholar at Johns Hopkins Center for Health Security said, “Viruses used to spread at the speed of a steamboat. Now, they can spread at the speed of a jet. In that sense, we’re more at risk.” The only way to adapt to the expanding threat of disease is to learn from the past and prepare for the trends of the future. Below is a list of some of the most devastating pandemics in history and how humanity’s response to disease changed because of them.

1. The Bubonic Plague 

14th Century CE

The plague of Florence, 1348. Boccacio’s Decam Wellcome. CC-BY-4.0.

Also known as the Black Death, the Bubonic Plague is the most notorious pandemic in history. It is believed to have killed between 30–50% of the European population in the 14th century, anywhere between 75 million and 200 million people. The Bubonic Plague is also thought to have killed 25 million people in Asia and Northern Africa at the time. The Black Death is known to have an incredibly high mortality rate, killing between 30-100% of those afflicted depending on the manner of infection. 

The Bubonic Plague spread globally as a result of the Silk Road, which connected the world through trade networks. Rodents carrying fleas infected with the plague were easy stow-aways in trading caravans and vessels. This is one of the first instances where globalization caused a deadly, widespread disease outbreak. 

At the time, the Black Death was thought to be the result of a combination of bad air, an imbalance in the body’s fluids or “humors,” and the wrath of God. Treatments included potions, fumigations, bloodletting, pastes, animal cures and religious cures. Persecution of minority groups was also common, particularly the Jewish population, who became a scapegoat for the suffering caused by the plague. Despite the outlandish and sometimes brutal practices of the 14th century, one method developed in the wake of the Black Death has proved incredibly effective: quarantine. Though, like today, many medieval citizens did not abide by quarantine practices, implementation of — to use a contemporary term — social distancing was one of the few effective practices to slow the spread of the Bubonic Plague.

2. Tuberculosis

7,000 BC – present day

A sick woman lies on a balcony with death standing over her, representing tuberculosis. Richard Tennant Cooper. CC-BY-4.0.

The sheer scope of tuberculosis in human history is almost difficult to fathom. Tuberculosis in humans can be traced back 9,000 years to Atlit Yam, a city now under the Mediterranean Sea, where archeologists found the disease in the bodies of a mother and child buried together. Tuberculosis, which has gone by many names throughout time, including “the white death” in the 1700s and “consumption” in the 1800s, is one of humanity’s great enemies. According to the CDC, from the 1600s–1800s, Tuberculosis was responsible for 25% of all deaths. 

Today, vaccines and antibiotics are available to prevent and treat tuberculosis. These developments in tuberculosis treatments saved 74 million lives between 2000 and 2021. However, despite this breakthrough in modern medicine, a total of 1.6 million people died from tuberculosis in 2021 according to the World Health Organization. Over 80% of these deaths come from low and middle income countries. Modern medicine means that Tuberculosis is treatable, but these treatments are not universally accessible. In a globalized world, access to healthcare cannot be a first world luxury if outbreaks are to be prevented. 

3. The Columbian Exchange

1492–1800 CE

Spanish imperialists conquer the Americas. Wilfredor. CC-BY-SA.

The Columbian Exchange is a massive interchange of people, animals, plants, and diseases that took place between Eastern and Western Hemispheres after Columbus’ arrival in the Americas in 1492. This process introduced a number of foreign diseases that Native Americans had no immunity to, whose toll reached genocidal proportions, killing between 80–95% of Indigenous Americans within 100–150 years of Columbus’ first landing. Some of the diseases that plagued the Native Americans include smallpox, measles, influenza, chickenpox, the bubonic plague, typhus, scarlet fever, pneumonia and malaria. European imperialism is to blame for the catastrophic spread of disease to the Indigenous population.

4. The Spanish Flu

1918–1919 CE

Infected patients were isolated during the 1918 Spanish Flu pandemic. Jim Forest. CC-BY-NC-ND 2.0.

After WWI, global contact and poor sanitary conditions during the war caused a worldwide outbreak of the H1N1 influenza virus, known at the time as the Spanish Flu. 500 million people were infected, one third of the world’s population at the time. Of those infected, 50 million people died worldwide, including 675,000 people in the United States. 

This pandemic led to a number of medical innovations still in use today. One of which is the widespread use of masks to prevent the spread of disease. The Spanish Flu pandemic also led to innovations in vaccine technology and spurred our understanding of genes and the chemicals that encode them.

5. AIDS Epidemic

1981-1990s

Protestors march against the stigma caused by the AIDs epidemic. NIH History Office. CC0.

HIV originally jumped from chimpanzees to humans in the early ‘80s, most likely due to human hunters coming into contact with chimpanzee blood. As a result, 84 million people have been infected globally and 40 million people have died. The AIDS epidemic is notorious for the resulting stigmatization of the LGBTQ+ community, which were greatly, though not uniquely, affected by the disease. Epidemics throughout history, since the Bubonic Plague, have caused hysteria and scapegoating, a flaw in human nature that must be quelled. 

Since the 1980s incredible strides have been made in the treatment of HIV and AIDS. As of 2021, 38.4 million people were living with HIV without it progressing to AIDS (when deadly symptoms appear) due to modern treatments. The treatment for HIV is taking daily antiretroviral therapy (ART), which is a cocktail of different HIV medicines. This treatment can allow people to live with HIV for decades without it progressing to AIDS.

Sophia Larson

Sophia Larson is a recent graduate of Barnard College at Columbia University. She previously worked as the Assistant Editor on the 2021 book Young People of the Pandemic. She has also participated as a writer and editor at several student news publications, including “The UMass Daily Collegian” and “Bwog, Columbia Student News.”

How Malaria Might Make a Comeback in the US

In order to prevent another pandemic so soon after the last one, US authorities need to stop this new malaria outbreak in its tracks.

The female Anopheles mosquito plays host to the disease’s parasite. CC BY-SA 2.0

Over the past two months, seven cases of locally acquired malaria have been identified in the US. These cases, six of which appeared in Florida and one in Texas, have drawn significant attention as the first time in 20 years the disease has been transmitted domestically. At present, the Center for Disease Control and Prevention (CDC) has reported that all five patients have received medical treatment and are recovering positively, and that the risk of malaria reappearing in a more widespread epidemic across the U.S. is extremely low. That being said, this is a good reminder for those in charge of American public health infrastructure to reflect on how best to shore up national defenses, especially in the wake of the recent Covid-19 pandemic.

Malaria is caused by parasites, which commonly infect Anopheles mosquitoes, and who in turn transfer the disease to humans when they inject their proboscises into our bloodstreams. There are several species of the malaria parasite, collectively known as Plasmodium, some of which cause more serious cases than others, but all of which require tropical climates to thrive. Regardless of the species, malaria is still extremely serious and symptoms such as high fevers, chills, and nausea begin to manifest in a few weeks. Most worryingly is that malaria, if left untreated, is fatal. As of 2021, the World Health Organization (WHO) believed that a grand total of 247 million cases of malaria occurred around the world, of which 619,000 were fatal. The majority of these deaths were children in various countries in Africa, where malaria is a constant present threat and contributes to a vicious cycle of social and economic poverty, taking a massive toll on countries in already precarious situations.

Malaria awareness in the US during the 1950s. Library of Congress. CC BY-NC-ND 2.0

At the beginning of the 20th century, malaria was considered an extremely serious issue in the US; the CDC was actually founded in 1946 to eliminate the disease. Over the next six years, various public health measures such as insecticide use and window screens were implemented to reduce the 15,000 cases reported in 1947, and in 1951, the CDC finally announced that malaria was in the US no longer. This remained the case for decades, until an incident in 2003 when eight locally acquired cases in Palm Beach, Florida were identified. Fortunately, the outbreak was quickly quashed thanks to an immediate response campaign that completely rid the area of mosquitoes to prevent transmission. Since then, malaria has remained fairly absent from the American healthcare landscape.

It is important to note, however, that malaria has never been completely extinct in the US; prior to the recent COVID-19 pandemic, roughly 2,000 cases of the disease were identified and reported annually in patients who had traveled to countries with high incidences of malaria in Southeast Asia and Africa. Additionally, once infected individuals return to the US, local mosquitos who feed on them can pick up the parasite and spread it further. Every so often, this may result in a small reintroduction of the disease and potentially even some limited transmission, but there has never been any worry of it resulting in a much widespread epidemic.

The malaria parasite pictured under a microscope. Joseph Takahashi Lab. CC BY-NC-ND 2.0

The reason these recent cases received so much attention were that all five were acquired locally within the US, which likely indicates that the parasitic mosquito population has made a resurgence as well. Thankfully, the species of parasite identified to have caused this small outbreak is known to transmit one of the milder forms of the disease, but that in no way detracts from the gravity of the situation. Matters of public health have become much more salient in regular discourse since the COVID-19 pandemic, and with it, some extreme opinions about containing and treating transmissible diseases. While America’s healthcare infrastructure continues to operate in largely the same way as it did during the 2003 outbreak, experts have agreed that public cooperation is now more important than ever if this re-appearance is to be nipped in the bud.

The RTS,S malaria vaccine. TheScientist. CC BY-SA 2.0

One particular area in which this agreement would go a long way, is that surrounding the efficacy of vaccines. In October of 2021, the WHO officially recommended the use of the RTS,S malaria vaccine developed by GlaxoSmithKline to prevent transmission in regions with high incidences of the disease. In addition to being logistically simple to store and administer, trials proved that the vaccine was beneficial to 90% of those treated, a staggering figure in the world of pharmaceutical development. Introducing the vaccine to the U.S. seems like an obvious step to take in the wake of these recent malaria cases, especially given the low price of a single dose at $9.30.

Vaccines have been a hotspot of controversy over the past few years, with many people denouncing both their safety and efficacy as a preventative treatment. Government authorities and healthcare professionals and academics around the world continue to release studies and evidence to show that vaccines are essential to build up individual and population-wide resistance  to a variety of diseases, but large groups of the public still remain unconvinced. Among the many lessons and important takeaways from the COVID-19 pandemic, the importance of vaccinations is among the most important, especially in the face of a potential re-emergence of a disease as deadly as malaria.

Tanaya Vohra

Tanaya is an undergraduate student pursuing a major in Public Health at the University of Chicago. She's lived in Asia, Europe and North America and wants to share her love of travel and exploring new cultures through her writing.

Structural Violence: How Societal Factors Affect Health

Income, race and geographic location are often weaponized against communities, preventing them from accessing and achieving health and wellness.

A routine doctor’s appointment may be rare for those living in poverty, causing them to not seek treatment for incipient medical issues. #PACOM. CC BY-NC-ND 2.0.

Income, geographical location, climate and access to resources all affect people’s health in various ways. Indeed, it is rare to get malaria, a mosquito-borne disease in the Arctic. It is also comparatively easier for a wealthy person who has access to top-notch treatments to recover from cancer than a disadvantaged person who cannot afford a routine doctor’s appointment. These societal factors have a proven link to health outcomes, and they are usually not controlled by individuals. To fully foster public health, it is necessary to eliminate those societal factors that precipitate health concerns.

There are both biological and societal factors that affect health. Biologically, genetics can affect one’s health, as the causal relationship between genetics and diseases such as cystic fibrosis have been demonstrated through medical research. However, biological factors are not the only thing that affects health; societal factors do as well. The World Health Organization (WHO) defines social determinants of health as: 

The non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.

Sometimes, the system itself is rigged against a substantial part of the population from attaining complete physical, social and emotional well-being. That is called structural violence. These arrangements are ‘structural’ because they are “embedded in the political and economic organization” of society, and they are ‘violent’ because they harm people, whether physically or not. 

Lowndes County, Alabama, where the low-income Black population suffers disproportionately from hookworm infections due to structural violence. jimmywayne. CC BY-NC-ND 2.0.

One example of these biosocial determinants and structural violence in play can be found in rural Alabama, where hookworm, a disease thought to be eradicated years ago, is making a resurgence in Lowndes County. That county is 72% Black and has a poverty rate of 21.9%, almost double the national average of 11.4% in 2020. Low-income Blacks in the county are more prone to hookworm because they live next to pools of raw sewage, the perfect breeding ground for the worms. 

Structural violence is also at play here, as the Black population live near the pools of raw sewage because they cannot afford proper sewage systems. The local and state government, in turn, perpetuates this problem by turning a blind eye on the issue and not providing any assistance to the residents. Through no fault of their own, Blacks in Lowndes County have a heightened risk for hookworm due to the circumstance in which society makes them live.

Cultural practices can also precipitate or hinder disease. West African countries that already had fragile healthcare systems were particularly affected by the 2014 Ebola outbreak because of cultural practices regarding funerals. In those cultures, funerals involve washing the dead body by hand before burial and paying respect to the dead through physical contact, both of which are exceptionally high-risk activities with regards to the spread of Ebola, since the virus is still present in the corpse. Controlling the Ebola outbreak must address these cultural issues.

Finally, around the world, food deserts are scattered around urban centers, usually located in areas of poverty. Food deserts are areas with a dearth of supermarkets and other sources of healthy foods, forcing people living there to travel further for quality foods or to settle for cheaper unhealthy foods. Since many food deserts are in areas of poverty, the people living in those areas usually have no choice but to buy cheap  foods with subpar qualities. The unhealthy diet of many in those areas lead to higher rates of obesity and cardiovascular disease.

Structural violence affects food deserts, as the economic disincentives for healthy food sources to serve low-income areas show that society does not provide adequate support to them. In northern Ireland, food deserts are especially pronounced since 32% of households do not have a car. Some food deserts are the result of years of neglect of marginalized communities. Failure of the UK government to provide adequate public transportation in northern Ireland demonstrates that neglect.

Simply treating disease without regard for the underlying causes of it will not eliminate the issue. To eliminate hookworm, proper sanitation services must be implemented. Containing Ebola means educating local communities about safe methods to bury the dead in a way that does not denigrate their culture. To eliminate obesity, focus should be on providing access to healthy foods instead of just telling people to change their diet. It is important to treat diseases as complex issues instead of having a singular focus on the cure. Removing societal barriers to good health is instrumental in ensuring the physical, social and emotional health for all.

To Get Involved

The organization Partners in Health serves to improve healthcare in developing countries through patient-provider partnerships. Partners in Health works to create sustainable healthcare systems that serve all, emphasizing healthcare as a human right.

Often, the best way to remove the societal factors that affect health negatively is by advocacy. Writing to your elected officials is a good way to draw attention to those issues, which may spur them to act on your recommendations. To find your representative in Congress, click here.

Bryan Fok

Bryan is currently a History and Global Affairs major at the University of Notre Dame. He aims to apply the notion of Integral Human Development as a framework for analyzing global issues. He enjoys hiking and visiting national parks.

The Influx of ‘Pisupo’: Food Colonialism in the South Pacific

Globalization has created an influx of unhealthy canned food in the South Pacific region, leading to a dependency on it and increasing health issues associated with an unhealthy diet. 

The influx of canned food in the South Pacific has led to a variety of problems. Salvation Army USA West. CC BY 2.0.

The legacy of colonialism has a lasting impact on the island of the South Pacific. Many of those islands have been colonized by Western powers, and some of them are still under the control of foreign countries. Due to this, Western influences are still pervasive throughout the region. 

One lasting legacy of Western imperialism in the South Pacific is the introduction of canned and processed food. The first canned food to be brought to the region was pea soup, and therefore, Samoan and a few other languages of the region, the word for canned food in general is “pisupo.” Today, the predominant type of canned food in the region is corned beef.

The prevalence of canned food in the South Pacific has changed the diets of the people living there and has caused a dependence on them. The new diets of the South Pacific Islanders are not necessarily an improvement from their traditional diets. However, as canned and processed foods are generally unhealthy and lacking in nutrients. That has resulted in an increase of obesity, diabetes and heart disease. Between 1990 and 2010, the total disability-adjusted life years lost to obesity also quadrupled in the region.

The traditional diets of South Pacific Islanders provide the nutrients needed for a healthy life. whl.travel. CC BY-NC-SA 2.0.

In order to provide these new foods, livestock such as cattle and pigs have been introduced to the islands, causing ecological damage. The island ecosystems are fragile, and large-scale ranching can easily destroy them. The dependence on canned food introduced by the West has resulted in not only harm to health, but also harm to the environment.

The proliferation of packaged and processed food has affected other parts of society as well, not just the typical diets. In marriage and birthday ceremonies in traditional South Pacific cultures, people often exchange gifts. While in the past, common gifts included fine mats and decorated barkcloths, but today, canned corned beef is one of the more popular gifts at those events. The introduction of canned foods has even changed traditional practices and contributed to the prevalent unhealthy diets of the South Pacific Islanders.

“Pisupo Lua Afe (Corned Beef 2000)” is a piece of art by Michael Tuffery that critiques the food dependency of the South Pacific. Sheep’R’Us. CC BY-NC-ND 2.0.

The neocolonial nature of these developments has its critics. One of them, Michael Tuffery, offers a unique interpretation through his artwork, with one of the most notable being “Pisupo Lua Afe,” a sculpture of a bull made from canned corned beef. He says that his art addresses the impact that the “exploitation of the Pacific’s natural resources has wrought on the traditional Pacific lifestyle.” His choice of subject matter and the material show his thoughts on the influx of canned food in the South Pacific. Bulls were a common presence at the aforementioned ceremonies, and the fact that the bull is covered in canned corned beef represents the fact that more traditional practices. Tuffery laments the changes that globalization has brought to his traditional Samoan culture, which has led to a “decline of indigenous cooking skills.”

With so much waste being created in the making of “Pisupo Lua Afe,” Tuffery calls into question whether the physical and cultural costs of food dependence are worth it. Could the South Pacific do better without the influx of canned food? Tuffery argues that it could. But even if the South Pacific Islanders decide to shun the prevalence of canned food, hurdles remain to improve the health of both the land and people of the region.

Bryan Fok

Bryan is currently a History and Global Affairs major at the University of Notre Dame. He aims to apply the notion of Integral Human Development as a framework for analyzing global issues. He enjoys hiking and visiting national parks.

Why Explosive Population Growth Is Unsustainable

The world is experiencing massive population growth, most of it in the Global South. If nothing is done to slow the rate, repercussions will be felt in politics, the economy and the environment.

A crowded street in Nairobi, Kenya, which has one of the highest population growth rates in the world. rogiro. CC BY-NC 2.0.

The world’s population is growing at an alarming rate. In 1950, the world’s population was estimated to be around 2.6 billion. In 2022, it is almost 7.9 billion. While it is true that the world theoretically has enough resources to support the entire current global population with room to spare, the rate of population increase is a cause for concern. Most of the world’s resources are concentrated in the countries of North America and Europe, but most of the world’s population growth is located in the Global South, which can negatively affect the development of those countries.

When agricultural societies start to industrialize, the death rate usually drops due to advances in medical care. The birth rate stays high for a while until social changes encourage more women to join the workforce and have fewer children. Many countries in sub-Saharan Africa are stuck in a demographic transition trap.

Current world population growth rate by country. Digital Dreams. CC BY 2.0.

As countries in the Global South start to industrialize, their death rates are falling, but their birth rates are not dropping to match the death rate, resulting in explosive population growth. This demographic trap occurs when “falling living standards reinforce the prevailing high fertility, which in turn reinforces the decline in living standards.” When developing countries do not make the necessary social changes to accompany industrialization, the birth rate stays high even as the economy transitions away from agriculture. These countries are slow to change their view on the ideal family size in light of emerging industrialization, and many are still engaged in labor intensive industries which reinforce the need for many children to provide free labor.

This explosive population growth has detrimental effects on both the developing country’s economy and environment. It leads to political instability, as the deluge of people overwhelm governments, causing states to fail. Governments likely cannot provide enough resources to the ever-growing population, trapping people in a cycle of poverty. Many families are impoverished due to using their resources for taking care of many children, perpetuating a cycle of poverty. 

The inability for a government to provide for its population results in a failed state. Of the 20 top failing states defined by the Failed States Index, 15 of them are growing between 2 and 4 percent a year. In 14 of those states, 40% or more of the population are under the age of 15. Large families are the norm in failing states, with women having an average of six children.

Not only does excessive population growth lead to failed states and economic problems, but it also leads to environmental problems as well. As the Global South develops, more and more people there are becoming consumers of energy and resources, contributing to climate change. In Madagascar, population growth has “triggered massive deforestation and massive species extinction.” The current rate of population growth is unsustainable in the long run economically, politically and environmentally.

However, previous efforts to decrease the birth rate in the Global South has led to the dehumanization of many women. According to Columbia professor Dr. Matthew Connelly, Americans developed programs to “motivate medical workers to insert IUDs [intrauterine devices] in more women” in South Korea and Taiwan, causing “untold misery” as there were not enough clinics to deal with the possible side effects of those procedures. Puerto Rico became a “proving ground for both the birth control pill and state-supported sterilization” due to American policy despite pushback from religious authorities. These efforts deprive women of their agency to plan their own families.

Interventions to limit population growth must ensure that families, and specifically women, have agency over their bodies. Comprehensive sexual education is an option to enable people to understand the reasons behind the different methods to decrease birth rates. Families must be able to make an informed choice on their family size, and such sexual education is a popular idea to achieve that in a humane and dignified manner.

Bryan Fok

Bryan is currently a History and Global Affairs major at the University of Notre Dame. He aims to apply the notion of Integral Human Development as a framework for analyzing global issues. He enjoys hiking and visiting national parks.

Eradicating Guinea Worm Disease: The Countdown to Zero

Guinea worm disease is on track to be the second disease eradicated from the world, but there is still work left to be done.

Health workers explain how to use water filters. uncultured. CC BY-NC-SA 2.0.

Guinea worm disease, also known as dracunculiasis, is an infection caused by the parasite Dracunculus medinensis. Larvae of the parasite are found in water sources in sub-Saharan Africa, and they can contaminate drinking water. Once consumed, the parasite stays inside the infected individual for up to a year as it grows into a worm until it removes itself from the human host, leaving through the skin. 

When the worm emerges from the human, it causes a painful skin blister, possibly resulting in a fever or secondary infection. There have been cases of people becoming crippled by a Guinea worm infection. The worm needs to be pulled out from the human body, several centimeters per day, by winding it around some gauze or a small stick. 

Health worker treating an infant with Guinea worm disease. Centers for Disease Control and Prevention. CC0 1.0.

In 1986, the Carter Center, the foundation of former president Jimmy Carter, began to lead the global campaign to eradicate Guinea worm disease. When the campaign started, there were 3.5 million cases of the disease in that one year. In 2021, there were only 15 reported human cases worldwide. This dramatic reduction of cases was the result of several carefully planned interventions.

The program to eradicate Guinea worm disease is community-based and relies on extensive villager volunteers. This approach respects the dignity of the people affected and builds trust between the community members and health professionals. The Carter Center aims to work with ministries of health to provide comprehensive health education and maintain political will.

Surveillance and supervision is instrumental in containing the spread of the disease. In the Gambella region of Ethiopia, village volunteers try to ascertain possible cases among their peers every week. When a suspected case is found, an investigation occurs. A lab test is needed to confirm a case of Guinea worm disease. The infected person’s demographics and symptoms are also tracked, as is information about the water sources that the person used. There are also community meetings to inform them of those infected. This is why gaining the trust of communities is so important. Community participation, especially in light of the stigma associated with the disease, is vital in containing the disease, and it all depends on trust.

As Guinea worm disease is waterborne and is contracted by drinking water contaminated with the larvae, interventions that involve treating water before it is drunk is essential. The Carter Center has distributed pipe filters to affected populations and taught them how to use them to prevent the new cases of the disease. In some places, the pesticide abate is applied to water sources to kill the larvae that cause Guinea worm disease. These interventions have drastically reduced the prevalence of Guinea worm disease, but the fight is not over yet.

While great progress has been made in eliminating Guinea worm disease in much of the world, some challenges have arisen. Civil unrest and political instability in some places where Guinea worm disease is prevalent have prevented efforts to combat the disease. Ethiopia, which had some of the highest rates of the disease, is mired in a civil war, making it hard to reach everyone affected by Guinea worm disease. Recently, cases of Guinea worm disease have also started to appear in animals. Today, most cases of Guinea worm disease occur in other animals, not humans. Complete eradication of Guinea worm disease cannot be completed until the world is free of the disease in both humans and animals.

To Get Involved

While the Carter Center is the leader in the drive to eradicate Guinea worm disease, there are also other partners and stakeholders in the campaign who can be supported through donations and volunteering. Among them include the ministries of health of affected countries, UNICEF, WHO, Ethiopian Public Health Institute and the UNHCR.

Bryan Fok

Bryan is currently a History and Global Affairs major at the University of Notre Dame. He aims to apply the notion of Integral Human Development as a framework for analyzing global issues. He enjoys hiking and visiting national parks.

W.H.O. Approves First-Ever Malaria Vaccine

On October 6,  the World Health Organization recommended the vaccine Mosquirix for widespread use against the deadliest malaria-causing parasite. The vaccine is anticipated to save the lives of over 100,000 young children living in sub-Saharan Africa.

Malaria Vaccine. tpsdave. CC BY 2.0. 

On October 6, the WHO Director-General announced the UN agency’s approval of humanity’s first vaccine against malaria for broad rollout. Dr. Tedros Adhanom Ghebreyesus termed the announcement a ‘historic moment’ and a ‘glimmer of hope’ for sub-Saharan infants and children, who are the most vulnerable demographic to die from the parasitic disease.

Disease Background

Malaria is a life-threatening infectious disease caused by the Plasmodium” family of protozoan parasites. The disease is transmitted via mosquito bites rather than human contact.  Mosquitoes’ saliva can pick up the parasite from an infected person, then give the parasite to the enxt healhty person they bite. Upon contraction, the parasite circulates throughout the human bloodstream and destroys  their red blood cells. Within two to four weeks of contraction, malaria symptoms such as fever, aches, chills, nausea and vomiting occur. Severe cases of malaria can cause anemia and jaundice, and if left untreated, it can cause seizures, kidney failure, coma or death. 

Disease Burden

Though there are nearly 230 million cases of malaria worldwide, Africa pays the greatest price. The continent sees 94% of malaria cases globally, where six countries account for approximately half of all reported malaria deaths: Nigeria (23%), Democratic Republic of Congo (11%), United Republic of Tanzania (5%), Burkina Faso (4%), Mozambique (4%) and Niger (4%). While malaria occurs in other regions such as South America, the disease predominantly wreaks havoc upon the planet’s poorest continent.

Children under the age of five are twice as likely as older patients to die upon contraction. For example, of the 409,000 global deaths caused by malaria in 2019, children five years or younger accounted for 67% of them. 

Africa’s disproportionate prevalence of malaria is the result of a confluence of factors. First, the continent’s tropical and subtropical climates are perfect conditions for marsh mosquitos year-round.  Second, relative socio-political instability and lagging economic development have made it difficult to implement large-scale preventive public health practices like mosquito nets and insecticide sprays that are needed to curtail transmission. 

Vaccine Information

After a decade of clinical trials operating within seven African countries, the World Health Organization coordinated a pilot program to evaluate the safety and efficacy of the Mosquirix vaccine (GlaxoSmithKline’s RTS,S). The trials served 15,000 infants and young children in Ghana, Kenya and Malawi. The trial found that Mosquirix is feasible and cost-effective to deliver to the public, even amidst the COVID-19 pandemic. Equitable access to malaria prevention is now a reality thanks to the Mosquirix vaccine’s approval. 

However, there are some logistical obstacles that countries will need to navigate because Mosquirix is imperfect. The vaccine was shown to prevent about four in ten malaria cases. The dosage structure is also time-intensive. One must receive three doses in three months, followed by a final injection a year later. This vaccination timeline will likely be the biggest obstacle. Peter Agre, the head of Johns Hopkins Malaria Research Institute, acknowledges “from an objective level most are disappointed that [Mosquirix] wasn’t more effective”. 

Nevertheless, public health experts are excited about Mosquirix’s potential. Of more than 2.3 million total doses injected throughout the pilot, the vaccine reduced severe malaria by 30%. In addition it reached two-thirds of children lacking a bed-net to sleep under. As the Director of the WHO Global Malaria Programme, Dr. Pedro Alonso states, “We’ve been looking for a malaria vaccine for over 100 years now. This will save lives and prevent disease.”

Rohan A. Rastogi

Rohan is an engineering graduate from Brown University. He is passionate about both writing and travel, and strives to blend critical thinking with creative communication to better understand the places, problems, and people living throughout the world. Ultimately, he hopes to apply his love for learning and story-sharing skills to resolve challenges affecting justice, equity, and humanity.

Report Finds W.H.O. Workers Sexually Exploited Women During Ebola Mission

Women were sexually exploited and abused by aid workers in order to obtain or keep jobs during the Ebola Crisis in the Democratic Republic of Congo.

A young girl washes her hands at a checkpoint at the border between Uganda and the DRC. UK Department for International Development. CC BY 2.0

According to a report commissioned by the agency’s head, World Health Organization workers sexually abused women while in the Democratic Republic of the Congo to aid the Ebola outbreak from 2018 to 2020. The report found that 83 people participated in the abuse, and in 21 cases, those involved were confirmed to be WHO officials. The investigation started in September 2020 when The New Humanitarian and the Thomas Reuters Foundation published a report investigating abuse claims. The report found that 31 out of 50 women interviewed reported abuse and exploitation from men working for the WHO. In response, leadership in the World Health Organization ordered an independent commission to investigate. After working in Beni, one woman interviewed by the commission stated, “To get ahead in the job, you had to have sex … Everyone had sex in exchange for something. It was very common.” In addition, women reported that they were sexually harrassed and faced exploitation in order to keep their jobs, get paid or get a promotion. In some cases women were dismissed from their jobs when they refused to have sex with supervisors.

The commission established that the majority of the victims were already vulnerable because of precarious social and economic status, and women with more education and economic power were less vulnerable to abuse. The report found that there was a “systematic tendency to reject all reports of sexual exploitation and abuse unless they were made in writing”. While the WHO has training in place to prevent sexual abuse, the report found that training for employees did not happen until November 2019, months after the outbreak had been declared an emergency. Only 371 out of 2,800 workers attended the training. Additionally, men make up the vast majority of employees during the crisis, averaging 73.4% overall. The report cites that men held 77.49% of leadership positions and 91.52% of operations support and logistic positions.

The WHO was not the only organization accused of abuse, The New Humanitarian’s investigation found that there were allegations against workers at World Vision, Unicef and Alima, among others. Additionally, the investigation found that underreporting was prevalent in these cases, with one woman stating, “Why would you even ask if I reported it?” The New Humanitarian found that many women were unaware of how to report abuse or exploitation at all. Most aid agencies claimed they had received no reports of abuse, and the WHO stated they had received only a small number of complaints. ​​Dr. Tedros Adhanom Ghebreyesus, the Director-General of the WHO, apologized to victims and said it was his top priority to hold perpetrators accountable during a press conference after the report’s publication.

Dana Flynn

Dana is a recent graduate from Tufts University with a degree in English. While at Tufts she enjoyed working on a campus literary magazine and reading as much as possible. Originally from the Pacific Northwest, she loves to explore and learn new things.

Oregon and Washington State Rethink the War on Drugs

A new law in Oregon decriminalized possession of small quantities of hard drugs. With Washington state possibly following its lead, the war on drugs might begin to be phased out.

Is the end in sight for the war on drugs? Thomas Martinsen. CC BY-NC-SA 3.0.

Currently, an Oregon police officer cannot arrest someone for possession of small amounts of heroin, meth, LSD or any other hard drug. Ballot Measure 110, voted into law last November, decriminalized the possession of small quantities of such substances. Instead of a felony conviction and jail time, a drug user caught red-handed will face either a $100 fine or a medical evaluation that could direct them to an Addiction Recovery Center (ARC). The new law fundamentally changes the state’s approach to epidemic rates of drug use and could revolutionize the role of Oregon’s police force. 

At its core, Ballot Measure 110 diverts drug users away from the criminal justice system and toward the health care system. The bill requires that a network of 15 ARCs be built to treat drug users and pair them with case workers who can help them reach sobriety. Funding for the ARCs will come, ironically, from tax revenue from legal marijuana sales. Oregon can expect a lot of money from such sales. In 2020, tax revenue from marijuana reached $133 million, a 30% increase from the previous year. Additionally, the state anticipates that more funds will appear as police stop pursuing arrests for drug possession.

The simple demotion of drug possession from a felony to a misdemeanor will have lasting repercussions. Before, an Oregon police officer who saw a pipe in a car could justify searching the car for illegal substances, since the pipe was proof of a possible felony. Now that it would indicate only a misdemeanor, the officer cannot search the vehicle. Arrests will decrease sharply as a result. The Oregon Criminal Justice Commission estimates that there will be 3,679 fewer arrests for possession per year, a 90.7% decrease. Distributors will still face criminal sentences since they possess drugs in large quantities, but users will receive health care, not jail time.

A disease, not a crime. Drugs Treatment Clinic Parus. CC BY-SA 4.0.

Building 15 ARCs by Oct. 1 will be a substantial challenge. Oregon will need to transition from addiction recovery programs focused on prisons to separate health care facilities that require supplies, staff and resources. Already, officers have made fewer arrests for possession to mitigate the risk of COVID-19 outbreaks in prisons. Thousands of drug users who would have landed in jails will now be placed into ARCs. Many who argued against the ballot measure now question whether so many facilities can be built by October. 

They have other qualms, too. As crude as the criminal justice system can be, drug addicts who served time in prison often entered court-mandated treatment programs; this won’t happen now that drug possession is a misdemeanor. County sheriffs expressed concern at a potential surge in illegal drug use now that prison is not a deterrent. Since the ballot measure passed with 58.5% of the vote, it’s clear these arguments weren’t entirely persuasive. 

The least worst option? Michael Kappel. CC BY-NC 2.0.

For one, prison might be the worst place to overcome a drug dependency. An addict is thrust into an unfamiliar environment to undergo withdrawal, and they may cope with trauma by self-medicating when the opportunity arises. The risk for opioid overdose alone is 129 times higher than average in the first two weeks after being released from jail. As for a potential surge in drug use, multiple examples of decriminalization in other countries indicate that this will most likely not occur. After decriminalizing hard drugs in Portugal, rates of drug use remained steady, but drug deaths fell as the percentage of users treated for addiction rose 21% between 2001 and 2008. 

Criticisms of Ballot Measure 110 go beyond the issue of how to treat epidemic rates of drug addiction. They speak to a concern about the ability of Oregon’s health care infrastructure to manage the flow of drug users from prisons to ARCs. This transition plays into a more ambitious, long-term agenda that many advocates of Ballot Measure 110 advocate for: defunding the police. By turning criminals into patients, ARCs would take the issue of drug addiction and mental health crises away from police; Oregon is even considering an alternative to 911 that people can call for drug-related issues or mental health crises.          

A Black Lives Matter protest in Portland, Oregon. Matthew Roth. CC BY-NC 2.0.

Washington state is considering a similar transition with House Bill 1499, which if passed would decriminalize drugs much the same way as Oregon’s Ballot Measure 110. Revenue for Washington state’s ARCs would come not from marijuA Black Lives Matter protest in Portland, Oregon. Matthew Roth. CC BY-NC 2.0.ana sales but from taxes on pharmaceutical companies, which played a large role in starting the opioid epidemic. Washington state currently has a program designed to lead drug addicts away from the criminal justice system and into treatment centers, the Law Enforcement Assisted Diversion (LEAD) program. It differs from other diversion programs in that it provides care before, not after, an arrest and takes referrals from community members, not just law enforcement. Nationwide, the program has been held up as a model diversion program.

Both states will struggle to make a seamless transition from prisoners to patients. It requires reforming two systems that often become embroiled in partisan conflicts. When the Seattle City Council cut its police department’s budget by 11%, in part to fund diversion programs, 186 police officers quit in response. Oregon will labor to build 15 ARCs by October, even with abundant funding from marijuana sales. Despite the state’s efforts, success depends largely on ever-shifting political winds.

Michael McCarthy

Michael is an undergraduate student at Haverford College, dodging the pandemic by taking a gap year. He writes in a variety of genres, and his time in high school debate renders political writing an inevitable fascination. Writing at Catalyst and the Bi-Co News, a student-run newspaper, provides an outlet for this passion. In the future, he intends to keep writing in mediums both informative and creative.

The Immense Impact of COVID-19 on Global Poverty

A pair of boys carry water near a refugee camp in Jowhar, Somalia. The COVID-19 pandemic has made conditions for marginalized groups such as refugees more dire. World Humanitarian Summit. CC BY-NC-ND 2.0

For the past 30 years, the world has been able to make immense progress in international development, with the amount of people living in extreme poverty (making below $1.90 a day) declining from 36% in 1990 to just 10% in 2015. The COVID-19 pandemic is reversing that. For the first time in three decades global poverty is on the rise, and up to half a billion people are now at risk of falling into poverty due to the coronavirus. Even more concerning is the matter of where the economic impacts of the virus are being felt the hardest, with the “global south” countries facing the highest risk of increased poverty for what could be years to come. 

In 2015, the U.N. adopted the 2030 Agenda for Sustainable Development, which included 17 goals acting as guidelines for the sustainable and equitable development of all member states. Known as the “sustainable development goals” (SDGs), the international community hoped that they would act as a framework for reducing inequality and promoting economic development. Poverty reduction is at the forefront of this initiative, with SDG 1 calling for the end of global poverty. That goal will most likely not be achieved by 2030. 

Even before the spread of the coronavirus, countries were not on track to completely eliminate poverty, with the U.N. estimating that 6% of the world population will still live in extreme poverty in 2030. Furthermore, the effects of the COVID-19 pandemic have made that goal even more difficult. In 2020 alone, more than 71 million people have fallen into extreme poverty, and millions more worldwide will likely fall into the same trap as the economic disruptions of the pandemic linger for years to come. 

(T)he number of school-age children facing food insecurity has increased by more than 320 million

The aggregate numbers do not portray the full extent of the impacts of COVID-19 on international development. Regions already susceptible to extreme poverty are being hit hardest by the economic impacts of the pandemic. According to the United Nations University, a 10% contraction in global per capita income would cause between 180 and 280 million people to fall into extreme poverty. However, the situation becomes more dire when one considers where people are expected to face increased rates of extreme poverty. Again assuming a 10% contraction, it is estimated that up to 85% of those newly living in poverty would be located in sub-Saharan Africa or South Asia alone. These regions already face disproportionate levels of poverty relative to their populations. For example, the African continent accounts for only 13% of the world population yet makes up over half of those living in extreme poverty. 

Those who were already at an increased risk for poverty, such as refugees, informal workers and those living in underdeveloped rural communities, are especially vulnerable to economic disruptions caused by the virus. The International Labor Organization estimates that between 5 and 25 million people could lose their jobs, which would create severe impacts for marginalized workers such as women and migrants. Additionally, the number of school-age children facing food insecurity has increased by more than 320 million according to the World Food Program.

The data shows a worrying trend that the international community must contend with to eliminate global poverty. Since the 1990s, the world has worked together to lift billions of people out of poverty and increase the global standard of living. Now, the COVID-19 pandemic has once again created a barrier to making a poverty-free future possible. The full extent of the virus’s impact has yet to be seen. However, what is already known is its effect on human livelihood, especially for those who are most at risk. The pandemic has created a new challenge for the international community if it wants to make extreme poverty a thing of the past. Yet, what can be achieved with global cooperation is immense, and the world’s vision for a sustainable future is still possible; it just might take a little bit longer than hoped for.

Aerex Narvasa

Aerex is a current student at Occidental College majoring in Diplomacy and World Affairs with a minor in East Asian Studies. He is passionate about sharing people’s stories through writing, and always strives to learn about new places and cultures. Aerex loves finding new music and exploring his hometown of Los Angeles in his free time.

Middle Eastern Countries Combat Stigma Surrounding Mental Health

While the stigmatization of mental health issues is common worldwide, sociocultural factors specific to the Middle East often prevent individuals from seeking treatment.

A drawing depicting mental health issues. Pixabay.

Mental health services are more urgently needed now than ever before. The world is currently facing a mental health epidemic, with over 264 million people struggling with depression in 2019. The additional stress and uncertainty caused by the COVID-19 pandemic have caused anxiety and depression levels to skyrocket. For many individuals, it has become even harder to participate in counseling programs. According to the World Economic Forum, over 93% of countries have reported a disruption in their mental health services since the pandemic started. 

In the Middle East, mental health awareness continues to rise, especially in the Gulf countries among the nations’ youth. A recent poll conducted in the Gulf region reported that 62% of youth agree that mental health issues are important. Even so, a recent survey in Saudi Arabia revealed that 80% of people struggling with severe mental health issues do not seek treatment. Similarly, this year’s Arab Youth Survey, which interviewed 4,000 young adults ages 18-24 from 17 Arab countries, revealed that mental health issues are rampant, with the number of people affected continuing to rise. 

Difficulties in Obtaining Proper Mental Health Care

The Kaaba in Mecca, Saudi Arabia, the holiest site in Islam. Konevi, Pixabay.

A prevalent culture of stigmatization in Middle Eastern countries prevents many individuals from seeking treatment in the first place. Due to the shame associated with mental health issues, privacy between the client and their mental health professional is of utmost concern. In many cases, mental health issues place a burden on a family’s reputation and social status. Rania Raine, a 43-year-old British-Egyptian art teacher who struggles with mental health, states that, “It’s the ‘shame’ families have, that their child isn’t perfect, that their lives are not perfect and what will people say, what will the neighbors say, society say–and then it all leads to marriage, how no one will marry the child who has a mental health condition, or worse still, ruin the chances of marriage of the other siblings.” 

Although the stigmatization of mental health conditions is common in Muslim communities, Ph.D. researcher Mounira al-Dousari states that they are “reflections of cultural practices and discourse.” There is a growing movement among mental health professionals to include faith in therapy, which results in a faster recovery for some clients. It’s also important to note that many forms of therapy use predominantly Western practices, which need to be diversified to appeal to a larger audience. According to Dousari, “When it comes to Islam, Muslim scholars and those working in the mental health field are working harder than ever to establish well-structured Islamically integrated psychotherapy models.”

Additionally, the financial burdens of seeking mental health treatment raise another concern. Even though mental health care is free in some public hospitals, many people do not trust them due to privacy concerns. Prices for private mental health care sessions are quite expensive. For example, Dousari’s research sessions cost $225 an hour, a large sum even for well-off families. 

Historic Treatment of Mental Illness in the Middle East

An entrance to the Moristan of Kala’oon, a mental health hospital in Egypt, 1878. Werner. CC2.5

Although mental health remains a prevalent issue in the region, the Middle East was well known for mental health treatment during the Islamic Golden Age. The term bimaristan, Persian for “home for the sick,” refers to entire psychiatric hospitals where a patient’s mind, body and soul were considered part of the treatment process. First opened in Fez, Morocco, and in Baghdad in the eighth century and later in Cairo, Damascus and Aleppo in the ninth, the practice was initially introduced by physician Ahmed ibn Sahl al-Balkhi. A famous manuscript written by Balkhi called “Sustenance for Bodies and Souls” was written in clear, understandable language and helped make mental health education more accessible to the public. Unfortunately, the practice declined throughout the centuries and does not occur in the mainstream today. 

Additionally, Dr. Mamoun Mobayed, director of the treatment and rehabilitation department at Behavioral Healthcare Center in Qatar, emphasizes that the stigmatization of diseases is a global phenomenon. “Any disease thought to be infectious or bizarre-looking, like leprosy, has always been stigmatized. Even with COVID-19, there have been cases where paramedics working with COVID-19 patients have been avoided due to the fear and stigma attached to the virus.”

In recent years, mental health awareness in the Middle East has become a top priority, with many countries starting their own wellness initiatives and campaigns. 

Qatar Paves the Way in the Gulf

Sidra Medical and Research Center in Qatar. Sergeev. CC3.0

Qatar launched a new mental health program in conjunction with World Mental Health Day. Being the first country in the Gulf to start such an initiative, the Wellness Ambassadors program aims “to promote mental health support and break the stigma attached to mental health conditions at school level.” Program ambassadors received comprehensive training on mental health issues such as anxiety, depression and bullying while breaking cultural misconceptions surrounding mental health. Dr. Mobayed states that educating individuals about mental health issues serves “to remove the barriers associated with mental health and know they are normal humans with a disorder in the mind.” 

Turkish Counseling Services Provide Assistance

Taksim Square in Istanbul. Pixabay.

A crisis helpline in Turkey helps those struggling with mental health issues during the pandemic. Supported by the World Health Organization, the service is accessible in all of Turkey’s 81 provinces and consists of 418 staff members trained in helping individuals manage stress and access mental health resources. So far, the service has offered more than 80,000 consultations since its inception. 

Social Media Campaigns in Kuwait Lead to Legislative Action

Youth in Kuwait. Wikimedia Commons. CC2.0

Kuwait enacted its first mental health law in 2019, which passed unanimously through the national assembly. Instrumental to this success were numerous social media campaigns led by youth, artists and mental health advocates. The founder of ASAP Beauty, Sheika Majda al-Sabah, credits her involvement in the campaign to her own struggles with depression. Other campaigns include “Mind Me”, “Human Line Organization” and “Taqabal”, with trending hashtags such as #noshame working to spread awareness. Outreach events helped to create a welcoming climate where people could speak more openly and denounce negative stereotypes surrounding mental illness. Since the onset of the COVID-19 pandemic, an online program called Corona Care provides mental health services for those in need. Additionally, the Gulf Program for Mental Health encourages countries to develop comprehensive mental health programs that adhere to international standards. 

Although there is still work needed to break down barriers surrounding mental health treatment, Middle Eastern countries seem ready to rise to the challenge. 

To Get Involved: 

Check out social media campaign pages “Mind Me”, “Human Line Organization” and “Taqabal” working toward mental health awareness in Kuwait. Visit the website of the Institute for Muslim Mental Health, which focuses on providing support for Muslims in the United States. The Journal of Muslim Mental Health is an excellent resource to learn about issues affecting the Muslim community in the United States and globally. 

Megan Gürer

Megan is a Turkish-American student at Wellesley College in Massachusetts studying Biological Sciences. Passionate about environmental issues and learning about other cultures, she dreams of exploring the globe. In her free time, she enjoys cooking, singing, and composing music.

Scotland Becomes First Country to Provide Free Period Products

The Period Products (Free Provision) (Scotland) Bill requires local authorities and schools to make sanitary materials free and available to all.

A woman passes a menstrual product to another. Annika Gordon. Unsplash.

On Nov. 24, Scotland became the first country to provide free and universal access to period products. In a tweet, the Scottish Labour Party confirmed that the bill had passed unanimously. This historic legislation was approved after a four-year grassroots campaign spearheaded by Scottish Labour’s health spokesperson, Monica Lennon.   

The Period Products (Free Provision) (Scotland) Bill is groundbreaking for several reasons. Not only does it aim to dispel period misconceptions, but it also functions to support individuals who struggle to care for themselves. A 2018 Scottish government study found that roughly 220,000 girls and women between the ages of 12 and 54 lived in relative poverty. Period products can cost about $10.75 per month. Although that might not seem like much, Lennon wrote in the 2017 proposal, “when you have no or very little income, it can be insurmountable.”

According to the United Nations Population Fund, menstruation is also an issue of human rights. Despite its natural occurrence, periods are often stigmatized. Consequently, limited conversations on menstrual health might make it difficult for those in need to seek adequate help. For instance, a December 2017 study condemned the menstrual hygiene plight of homeless women as a “public health disgrace.” Researchers reported that homeless women tend to reuse products despite cleanliness concerns such as toxic shock syndrome. An interviewee shared that her shelter provided only two pads, while the average woman uses approximately 20 pads per cycle.

Consequently, the passage of the Period Products Bill is a stepping-stone toward recognizing the worth of women as well as the unique challenges they face.  

What about other countries?

Like Scotland, China’s women are taking a stand. Jiang Jinjing, a women’s rights advocate, gained prominence after the COVID-19 outbreak hindered the distribution of supplies. She started the campaign Stand by Her in an effort to alleviate period poverty while also destigmatizing menstruation.  Her work has inspired both men and women to set up centers that provide free period products. In at least 338 schools and colleges across the country, boxes and bags of individually wrapped period products have already sprung up in bathrooms. While their network is still growing, Jiang believes that they have planted seeds of change. She also noted that their efforts have helped to normalize words like “pads” and “periods,” which, she notes, is a “huge milestone.”

New Zealand is another country that provides free sanitary products—but only to students enrolled in schools. Miranda Hitchings, a co-founder of Dignity, a nongovernmental organization that gives period products to those in need, lauded the move but emphasized that period poverty encompasses a wider population. While the situation has yet to evolve, New Zealand’s Minister for Women, Julie Anne Genter, recognized that menstruation is a fact of life and that “access to these products is a necessity, not a luxury.”

Moving forward

Ultimately, Scotland’s historic move could prove a necessary spark for many budding efforts around the world. By Jan. 1, 2021, the United Kingdom will no longer tax period products. Countries like Spain and Switzerland are also planning to reduce tampon taxes by about 5%. Until other countries follow suit, making period products free for all remains a key component toward attaining true gender equality. 


Rhiannon Koh

Rhiannon earned her B.A. in Urban Studies & Planning from UC San Diego. Her honors thesis was a speculative fiction piece exploring the aspects of surveillance technology, climate change, and the future of urbanized humanity. She is committed to expanding the stories we tell.

What Makes Bhutan So Happy?

Meet the country which prioritizes the contentment of its citizens before everything else through its “Gross National Happiness” program.

Bhutanese children. r y _ _ _ _ . CC BY-NC 2.0

Imagine a country hidden away from the rest of the world. Tucked in between China and India, the world’s most populous countries, little Bhutan rests at the base of the Himalayan mountains. The rural country long ago made the decision to close off its borders to most tourism in hopes of preserving the nation’s unique Buddhist culture and the identity of its 740,000 people. In 1974 the country gradually reopened, though the Bhutanese monarchy was reluctant for the nation to be connected with the rapidly urbanizing world. Bhutan could not be completely isolated for long due to globalization, and in 1999 internet and Wi-Fi were quickly introduced. Being alone for so long, Bhutan was innovative in ways that made sense for its culture and ecosystem.

Dochula Pass. Göran Höglund (Kartläsarn). CC BY 2.0

Bhutan is unique in its location and recent connections to the outside world, but it’s the traditions and customs within Bhutan that really make it a sight to behold. Even during the age of colonization and imperialization, Bhutan was never colonized. The country’s official religion remains Vajrayana Buddhism, a deity-dense, merit-based and karma-focused faith implemented into everyday life and routines. 

Bhutan Buddhist monk sand art. John K. CC BY-NC-ND 2.0

Dance of the death god. jmhullot. CC BY-SA 2.0

Ecology is everything. Bhutan is the only carbon negative nation in the modern world, absorbing three times more carbon than it produces. In light of climate change, that feat is revolutionary. Its government has established laws that require Bhutan to always have its area 60% covered in forest lands. Keeping in mind its minimal carbon footprint, Bhutan is still vigilant about tourists who enter the country, always prioritizing  the preservation of the nation’s cohesive identity. The tourist industry is nationally regulated, making it expensive and difficult to travel to. Documents and visas are issued by state-appointed companies and provide visitors with everything, including hotels, insurance and most importantly a guide who must accompany travelers at all times. 

Ecology is everything. 360around. CC BY 2.0

Ecology and tourism are not the only things the government has taken to regulating. Bhutan is once again unique in national policy, measuring its nation’s happiness. Outsiders like to say that Bhutan is the “happiest country in the world” and the statistics given by Bhutan back up this claim. In 2015, the annual extensive survey that gauges the nation’s happiness concluded that 91% of its population was happy.” The Ministry of Happiness measures the contentment of its population with “Gross National Happiness” (GNH). 

King of Bhutan. Bhutan-360. CC BY-NC-SA 2.0

Ex-Prime Minister Tshering Tobgay defined it as “a developing philosophy that acknowledges that economic growth is important, but that growth must not be mindless, but sustainable.”

Much like a country’s gross domestic product, GNH is considered important. Established in 2008, the Gross National Happiness Commission was appointed to take into consideration and care the inner peace of Bhutan’s people. Broken down into four pillars, nine domains and 72 indicators, GNH is a difficult concept to comprehend. The country’s leaders take into account how happy its people are in every aspect of life: governance, health, education, living standards, culture, ecology, time use and psychological well-being. 

Tobgay breaks Bhutan’s complicated process down to three components: the key to happiness is security, identity and purpose. These things are not mutually exclusive; they reinforce one another in every direction, both on an individual and a national level. He says that, “The government has a responsibility to ensure the whole nation has individual pursuit of the keys to happiness.” 

Temple overlooking the Himalayas. Jean Marie Hullot. CC BY-SA 2.0

The Bhutanese are often misunderstood. Outsiders often believe that just because they have GNH, it automatically makes them the happiest country in comparison to all others. They have free health care, free education, clean air, a thriving environment and a strong sense of community. But Tobgay argues that the Bhutanese still struggle because that is what it means to be human. Bhutan is a “real country with real people, and real desires.” Although every person may suffer from inner turmoil for whatever reason, the Bhutanese should be happy knowing that they have been given the keys to happiness.

Yuliana Rocio

Yuliana is currently a Literature/Writing major at the University of California San Diego. Yuliana likes to think of herself as a lover of words and a student of the world. She loves to read, swim, and paint in her free time. She spent her youth as part of a travel-loving family and has grown up seeking adventure. She hopes to develop her writing skills, creating work that reflects her voice and her fierce passion for activism.

Has South Africa’s Booze Ban Helped in the Fight Against COVID-19?

To slow the spread of COVID-19, the government banned alcohol sales. Now, the country asks, “Was it worth it?”

A South African enjoying a glass of wine. World Bank Photo Collection. CC BY-NC-ND 2.0.

South Africans woke up before dawn to line up in front of liquor stores. Since March 27, alcohol sales had been prohibited to curb the spread of COVID-19, but on June 1, nine long weeks of sobriety ended. With the threat of another surge in cases—and another prohibition on booze—looming over the country, drinkers nationwide stocked up while they had the chance.

The ban was a forceful and unprecedented measure for a country that has suffered the most cases of COVID-19 in Africa. The long lines demonstrated the important role alcohol plays in South African culture and social life, as does the annoyed reaction of many citizens. In a crowded country with many shared living spaces in urban areas, the ban on alcohol has often been viewed as an extraneous measure that has endangered innumerable small businesses and infantilized the South African people.

Alcohol figures into the country’s history in a variety of ways. Under apartheid, Black South Africans were forbidden from buying or consuming alcohol, so its consumption became an act of rebellion against racial injustice. For mixed-race workers in rural areas, many were paid in liquor rather than money, leading to dependency on the substance for thousands. In other areas, traditional methods of brewing beer have long provided locals with their own source. Under the ban, South Africans of every background, race and class have had to cut their consumption down to zero.

A South African woman brewing umqombothi, a traditional beer. GioRetti. CC-BY-NC-SA 2.0

The logic behind the ban was simple: limit alcohol use and more hospital beds will remain open. Though most abstain from drinking altogether, the World Health Organization (WHO) classifies the majority of those who use alcohol as binge drinkers. As a result, drinking-related incidents account for 40% of all of South Africa’s emergency hospital admissions. In addition, crime fell by 29% over the course of the ban, including rates for domestic abuse and sexual assault. It is estimated that because the ban allowed more space for COVID-19 patients, 515 lives were saved.

A similar logic was used to implement a ban on cigarettes. Citing research from the WHO, the government has claimed that the ban is necessary to slow the spread of COVID-19. Cigarette smoke can carry the virus in air molecules for longer distances, and smoking itself weakens the lungs and makes the body more susceptible to severe symptoms. While the ban on cigarettes was lifted on Aug. 18, its implications continue through a vibrant black market.

Smokers found numerous ways to buy cigarettes under the table, leading many to question whether the ban actually curtailed the spread of COVID-19. Cigarette dealers interact with dozens of clients a day, creating the potential to hasten the spread of the virus. 

The growth of the black market has been an unforeseen consequence of the alcohol and cigarette ban, but it will have lasting repercussions on South Africa’s economy. Illegal operators have gained a significant foothold by doing business with thousands of drinkers and smokers who previously had no interaction with South Africa’s criminal underworld. Reversing the growth of these criminal enterprises is predicted to take years.

Moreover, the South African revenue service lost out on a total of 12 billion rand, equal to $726 million, in taxes it would have collected had alcohol never been banned. This loss of revenue is all the more frustrating when the government has struggled to provide hospitals with the necessary supplies to handle COVID-19. On a smaller scale, too, the economy has been devastated. Innumerable businesses face financial ruin since restaurants derive roughly 60% of their profits from alcohol sales. 

A street party on Long Street in Cape Town. Flowcomm. CC BY 2.0.

It is impossible to say whether the alcohol ban will ever be implemented again; this largely depends on whether South Africa experiences another surge of cases. When cases spiked a second time this summer, the ban was reimplemented from July 12 to Sept. 20. There is no guarantee that the ban will not be needed again. 

If it does become necessary yet again, many have learned how to fulfill their desire for a drink without liquor stores. Homebrewing has enjoyed a resurgence because of the nationwide prohibition. City dwellers have begun experimenting with beers typically made only in rural areas. Online video guides for brewing pineapple beer and a traditional corn and sorghum beer known as “umqombothi” have garnered thousands of views. Try as the government might, South Africa’s thirst for alcohol will most likely prove insatiable.

Michael McCarthy

is an undergraduate student at Haverford College, dodging the pandemic by taking a gap year. He writes in a variety of genres, and his time in high school debate renders political writing an inevitable fascination. Writing at Catalyst and the Bi-Co News, a student-run newspaper, provides an outlet for this passion. In the future, he intends to keep writing in mediums both informative and creative.

Malaysian Princess Condemns Suicide Criminalization 

Malaysia is one of three Southeast Asian countries that still criminalizes suicide. To fight stigmas, mental health advocates have been pushing for reform and a more efficient health care system.

Pedestrians milling about a street market in Kuala Lumpur. Trey Ratcliff. CC BY-NC-SA 2.0.

On Sept. 10, World Suicide Prevention Day, Malaysian Princess Tengku Puteri Iman Afzan was appointed as the country’s international patron for World Mental Health Day 2020. This nomination was an encouraging sign for Malaysian mental health advocates for many reasons.

As a former British colony, Malaysia has codified an antiquated law criminalizing suicide. In Section 309 of Malaysia’s Penal Code, those who attempt and survive suicide must serve one year in prison, pay a fine, or both. Almost 60% of Malaysia’s population practices Islam, and suicide goes against the religion’s belief in the sanctity of life. Despite the stigma of suicide as a “sin,” a national study estimates that every day 10 people take their own lives. Subsequently, many human rights groups like the National Human Rights Society (HAKAM) and Minda are dedicated to raising mental health awareness and literacy. Activists hope that proper education will dispel the negative stereotypes that are preventing many from seeking the help they need.

Worshippers outside of a mosque in Malaysia. Firdaus Latif. CC BY-SA 2.0.

In an interview with The Guardian, chairman Justin Victor of emotional support hotline group Befrienders Kuala Lumpur, said that criminalization “is a deterrent to being able to speak about [suicide] openly.” Many individuals who survive are reluctant to seek help, fearing they could be charged again.

In the wake of the COVID-19 lockdown, the need for mental health care reform was made more apparent. Shahfirul Hakim Shahidan, 28, attempted suicide after facing unemployment. He was charged with “inconveniencing” others and fined 3,000 ringgit ($720). If Shahidan failed to pay, he would be jailed. The sentence was met with public outcry. Minds First, a youth group advocating for mental health awareness, organized a Change.org petition demanding the decriminalization of suicide. In its statement, the group argued that the “criminalization of suicide punishes those who need help and prevents them from getting the support they need.”

As of Oct. 11, the petition had gained nearly 19,000 signatures.

The skyline of Malaysia’s capital, Kuala Lumpur. Salehi Hassan. CC BY-NC 2.0.

Quarantine isolation has exacerbated existing mental health challenges. Befrienders Kuala Lumpur reported an increase in calls when the government first enforced social distancing measures. Publicity director Ardy Ayadali explained, “Being in isolation increases the fear and helplessness that someone feels … when someone is isolated in crowded families or spaces, the environment can get toxic.”

During the pandemic, however, Malaysia also launched its first mental health helpline for children. Buddy Bear is a hotline that lets children discuss whatever social and emotional issues they have, and gives advice on how they can deal with them. With professionally trained volunteers, children learn how to articulate and understand their feelings with a healthy approach.

Accordingly, many felt that Iman’s appointment would aid Malaysia’s advocacy work in mental health care. The princess has also struggled with anxiety and shared that although she is no longer ashamed of her troubles, she also knows “what it’s like to feel disempowered.” Iman noted that stigma was one of the biggest hurdles and applauded Malaysians’ struggle to attain mental health rights. During her acceptance speech, the princess publicly called for the decriminalization of suicide.

Rhiannon Koh

earned her B.A. in Urban Studies & Planning from UC San Diego. Her honors thesis was a speculative fiction piece exploring the aspects of surveillance technology, climate change, and the future of urbanized humanity. She is committed to expanding the stories we tell.